In 2001 Frumkin mentioned, “Perhaps we will advise patients to take a few days in the country, to spend time gardening, or to adopt a pet, if clinical evidence offers support for such measures.”
As to how nature-assisted mental health interventions might concretely manifest in practice, this, of course, will depend on the particular form of methodological and theoretical integration chosen (e.g., narrative, Gestalt, cognitive, solution-focused, experiential or generally positive psychological or even pharmaceutical approach to intervention).
Various kinds of Ecotherapy
There are several different established nature-assisted approaches, such as:
- Horticultural therapy
- Wilderness therapy
- Civic environmentalism
- Walking for health and the use of healing gardens.
Nature as a therapeutic/salutogenic context (or independent variable) may range from quests in the wilderness to passive contemplation in a garden to a natural view from the consulting room. Indeed, it is clear from the outset of this study, that there is a multitude of different parameters, which might influence the particular manifestation of clinical practice.
In addition to those earlier stated, i.e., whether a practice is group-based or solo, active or passive, we also need to take into account factors such as:
- the degree of therapist intervention
- therapist positioning
- goals of therapy
- client compliance
In the late 1990s and early 2000, several scientists such as Burns, Linden & Grut, Berger, Reynolds, and Townsend demonstrated several methodologies for the practice of Ecotherapy. Specific methodologies have ranged from:
- Burns’s outcome-directed use of the Sensory Awareness Inventory
- The elicitation of metaphor from either nature-based assignments or shared activity with a therapist (Burns, 1998; Linden & Grut, 2002)
- Use of ritual (Berger, 2006) to group involvement in a conservation project (Reynolds, 2002; Townsend, 2006).
- Suitable methodologies, which show particular promise in terms of amalgamation within a nature-assisted integrative approach, such as mindfulness/meditation in nature.
In terms of the practice of nature-assisted psychotherapy, nature may be drawn on as the client’s focus elicited homework assignments. Experiences in nature may be the source of therapeutic material taken up in therapy (for example, experiential metaphors may be drawn on – Ibid), or natural settings may be the real context of therapy itself. That is, the consulting room could be under open skies or in a greenhouse.
The field of nature-assisted clinical psychological intervention is still in its fledgeling days, and the need for the development of best practice models is most apparent. At a seminar on nature guided therapy in Copenhagen, the need for ideas and guidelines on how psychologists might practice integrative nature-based approaches was evident. Burls has highlighted the pressing need for training programs for ecotherapists. It has also recommended that future practitioners need extensive psychotherapeutic knowledge and multi-therapeutic skills, including those who may draw from nature as a therapeutic resource.